Variations in Coronary Revascularization Practices and Their Effect on Long-Term Outcomes
Rodolfo V Rocha1,2, Xuesong Wang2, Stephen E Fremes3,4
1Division of Cardiovascular Surgery Peter Munk Cardiac Centre University Health NetworkUniversity of Toronto Toronto ON Canada.
Journal of the American Heart Association
|February 28, 2022
Summary
Higher ratios of percutaneous coronary interventions to coronary artery bypass grafting procedures (PCI:CABG) in hospitals correlate with increased adverse cardiac events. Hospitals without on-site cardiac surgery also show higher risks for major adverse cardiac and cerebrovascular events.
Area of Science:
- Cardiology
- Health Services Research
Background:
- The variation in hospital-level percutaneous coronary intervention to coronary artery bypass grafting (PCI:CABG) ratios is not well understood.
- The clinical outcome implications of differing PCI:CABG ratios across hospitals remain unclear.
Purpose of the Study:
- To investigate the extent of hospital variation in PCI:CABG ratios.
- To determine the association between PCI:CABG ratios and patient clinical outcomes.
Main Methods:
- A multicenter, population-based study in Ontario, Canada, analyzed 44,288 patients with severe multivessel coronary artery disease undergoing revascularization (2013-2017).
- Hospitals were stratified into low, medium, and high PCI:CABG ratio tertiles.
- Clinical outcomes were compared across tertiles, adjusting for patient characteristics and hospital capabilities.
Main Results:
- Hospitals with higher PCI:CABG ratios (medium and high tertiles) showed significantly higher rates of major adverse cardiac and cerebrovascular events compared to low PCI:CABG ratio hospitals.
- Interventional cardiologists performing diagnostic angiograms increased the likelihood of patients receiving PCI.
- Diagnostic angiography at institutions lacking cardiac surgical capabilities was linked to increased risks of major adverse cardiac and cerebrovascular events, death, and myocardial infarction.
Conclusions:
- Patients treated at hospitals with higher PCI:CABG ratios experienced worse clinical outcomes, including increased major adverse cardiac and cerebrovascular events, myocardial infarction, and repeat revascularization.
- The presence of on-site cardiac surgery was associated with improved survival and reduced major adverse cardiac and cerebrovascular events, highlighting its importance in managing complex coronary artery disease.
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